Drawing the Line Between Postacute Sequelae of COVID-19 and Functional Neurologic Disorders: A Daunting Clinical Overlap or Irrelevant Conundrum?

ABSTRACT: Coronavirus disease 2019 (COVID-19) is an acute infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its multiple variants that classically presents with cough, fatigue, fever, headache, myalgias, and diarrhea. As vaccination becomes widely available and infection rates facilitate herd immunity across the globe, more attention has been given to long-term symptoms that may persist after the index infection, which include impairments in concentration, executive dysfunction, sensory disturbances, depression, anxiety, fatigue, and cough, among other symptoms classified under the umbrella term of postacute sequelae of SARS-CoV-2 infection (PASC).Functional neurologic disorder (FND), also known as conversion disorder and functional neurologic symptom disorder, refers to the presence of one or more symptoms of altered voluntary motor or sensory function that are incompatible with and not better explained by a known neurological or medical condition that causes significant distress and functional impairment. Although the diagnosis of FND may not require the identification of an underlying psychological stressor, being diagnosed with an FND can worsen stigma and shift attention and resources away from other medical concerns that should be concomitantly addressed.This review summarizes the literature on the overlapping nature and discrimination of PASC from FND in COVID-19 survivors. Based on this, we develop a treatment framework that targets unique domains of these complex overlapping presentations, following a multidisciplinary approach with an individualized treatment plan inclusive of physical and psychological interventions focused on functional rehabilitation.

A roadmap for observership programs in psychiatry for international medical graduates.

OBJECTIVE: International medical graduates (IMGs) constitute a significant proportion of the psychiatric workforce in the United States. Observership programs serve an important role in preparing IMGs for U.S. residency positions; yet there are limited resources with information available on establishing these observerships, and none specific to psychiatry. In this article, authors present a roadmap for observership programs in psychiatry for IMGs. METHOD: This article draws on the experience of the IMG committee of the Group for Advancement of Psychiatry in establishing observership programs. RESULTS: Authors highlight the benefits of observership programs to IMGs, psychiatry departments, and the U.S. medical system as a whole. The different components of an observership program are presented, along with core competencies that need to be acquired. The authors discuss challenges that observership programs may encounter as well as recommendations for overcoming them. CONCLUSION: Observership programs provide a unique opportunity to integrate IMGs into the U.S. medical system. This article provides a framework for establishing such programs in a way that will optimize their benefits and avoid potential pitfalls.

The Crypto-Apartheid of Race, Class, and Safety Arbitration on the Inpatient Psychiatric Unit.

Inpatient psychiatric treatment and violence assessment are strongly influenced by a patient's race and class identity. The authors argue that psychiatrists enact a crypto-apartheid wherein they recognize and condemn the structural racism and classism disadvantaging many patients, but through violence risk assessments and dispositional decisions, psychiatrists also function as arbiters of public safety and repeatedly disadvantage less-privileged patients to further symptomatic decline or even subsequent incarceration.

Dysfunctional reward processing in male alcoholics: an ERP study during a gambling task.

OBJECTIVE: A dysfunctional neural reward system has been shown to be associated with alcoholism. The current study aims to examine reward processing in male alcoholics by using event-related potentials (ERPs) as well as behavioral measures of impulsivity and risk-taking. METHODS: Outcome-related negativity (ORN/N2) and positivity (ORP/P3) derived from a single outcome gambling task were analyzed using a mixed model procedure. Current density was compared across groups and outcomes using standardized low resolution electromagnetic tomography (sLORETA). Behavioral scores were also compared across groups. Correlations of ERP factors with behavioral and impulsivity factors were also analyzed. RESULTS: Alcoholics showed significantly lower amplitude than controls during all outcome conditions for the ORP component and decreased amplitude during the loss conditions for the ORN component. Within conditions, gain produced higher amplitudes than loss conditions. Topographically, both groups had an anterior focus during loss conditions and posterior maxima during gain conditions, especially for the ORN component. Decreased ORP current density at cingulate gyrus and less negative ORN current density at sensory and motor areas characterized the alcoholics. Alcoholics had higher levels of impulsivity and risk-taking features than controls. CONCLUSIONS: Deficient outcome/reward processing and increased impulsivity and risk-taking observed in alcoholics may be at least partly due to reward deficiency and/or dysfunctional reward circuitry in the brain, suggesting that alcoholism can be considered as part of the cluster of the reward deficiency syndrome (RDS).

Brain signatures of monetary loss and gain: outcome-related potentials in a single outcome gambling task.

This study evaluates the event-related potential (ERP) components in a single outcome gambling task that involved monetary losses and gains. The participants were 50 healthy young volunteers (25 males and 25 females). The gambling task involved valence (loss and gain) and amount (50 cent and 10 cent) as outcomes. The outcome-related negativity (ORN/N2) and outcome-related positivity (ORP/P3) were analyzed and compared across conditions and gender. Monetary gain (compared to loss) and higher amount (50 cent compared to 10 cent) produced higher amplitudes and shorter latencies in both ORN and ORP components. Difference wave plots showed that earlier processing (200-400 ms) is dominated by the valence (loss/gain) while later processing (after 400 ms) is marked by the amount (50 cent/10 cent). Functional mapping using Low Resolution Electromagnetic Tomography (LORETA) indicated that the ORN separated the loss against gain in both genders, while the ORP activity distinguished the 50 cent against 10 cent in males. This study further strengthens the view that separate brain processes/circuitry may mediate loss and gain. Although there were no gender differences in behavioral and impulsivity scores, ORN and ORP measures for different task conditions had significant correlations with behavioral scores. This gambling paradigm may potentially offer valuable indicators to study outcome processing and impulsivity in normals as well as in clinical populations.